Pain, Pills & Will

There are many ways to die, but the public concern tends to focus on whatever is illuminated in the media spotlight. 2012 saw considerable focus on guns and some modest attention on a somewhat unexpected and perhaps ironic killer, namely pain medication. In the United States, about 20,000 people die each year (about one every 19 minutes) due to pain medication. This typically occurs from what is called “stacking”: a person will take multiple pain medications and sometimes add alcohol to the mix resulting in death. While some people might elect to use this as a method of suicide, most of the deaths appear to be accidental—that is, the person had no intention of ending his life.

The number of deaths is so high in part because of the volume of painkillers being consumed in the United States. Americans consume 80% of the world’s painkillers and the consumption jumped 600% from 1997 to 2007. Of course, one rather important matter is the reasons why there is such an excessive consumption of pain pills.

One reason is that doctors have been complicit in the increased use of pain medications. While there have been some efforts to cut back on prescribing pain medication, medical professionals were generally willing to write prescriptions for pain medication even in cases when such medicine was not medically necessary. This is similar to the over-prescribing of antibiotics that has come back to haunt us with drug resistant strains of bacteria. In some cases doctors no doubt simply prescribed the drugs to appease patients. In other cases profit was perhaps a motive. Fortunately, there have been serious efforts to address this matter in the medical community.

A second reason is that pharmaceutical companies did a good job selling their pain medications and encouraged doctors to prescribe them and patients to use them. While the industry had no intention of killing its customers, the pushing of pain medication has had that effect.

Of course, the doctors and pharmaceutical companies do not bear the main blame. While the companies supplied the product and the doctors provided the prescriptions, the patients had to want the drugs and use the drugs in order for this problem to reach the level of an epidemic.

The main causal factor would seem to be that the American attitude towards pain changed and resulted in the above mentioned 600% increase in the consumption of pain killers. In the past, Americans seemed more willing to tolerate pain and less willing to use heavy duty pain medications to treat relatively minor pains. These attitudes changed and now Americans are generally less willing to tolerate pain and more willing to turn to prescription pain killers. I regard this as a moral failing on the part of Americans.

As an athlete, I am no stranger to pain. I have suffered the usual assortment of injuries that go along with being a competitive runner and a martial artist. I also received some advanced education in pain when a fall tore my quadriceps tendon. As might be imagined, I have received numerous prescriptions for pain medication. However, I have used pain medications incredibly sparingly and if I do get a prescription filled, I usually end up properly disposing of the vast majority of the medication. I do admit that I did make use of pain medication when recovering from my tendon tear—the surgery involved a seven inch incision in my leg that cut down until the tendon was exposed. The doctor had to retrieve the tendon, drill holes through my knee cap to re-attach the tendon and then close the incision. As might be imagined, this was a source of considerable pain. However, I only used the pain medicine when I needed to sleep at night—I found that the pain tended to keep me awake at first. Some people did ask me if I had any problem resisting the lure of the pain medication (and a few people, jokingly I hope, asked for my extras). I had no trouble at all. Naturally, given that so many people are abusing pain medication, I did wonder about the differences between myself and my fellows who are hooked on pain medication—sometimes to the point of death.

A key part of the explanation is my system of values. When I was a kid, I was rather weak in regards to pain. I infer this is true of most people. However, my father and others endeavored to teach me that a boy should be tough in the face of pain. When I started running, I learned a lot about pain (I first started running in basketball shoes and got huge, bleeding blisters). My main lesson was that an athlete did not let pain defeat him and certainly did not let down the team just because something hurt. When I started martial arts, I learned a lot more about pain and how to endure it. This training instilled me with the belief that one should endure pain and that to give in to it would be dishonorable and wrong. This also includes the idea that the use of painkillers is undesirable. This was balanced by the accompanying belief, namely that a person should not needlessly injure his body. As might be suspected, I learned to distinguish between mere pain and actual damage occurring to my body.

Of course, the above just explains why I believe what I do—it does not serve to provide a moral argument for enduring pain and resisting the abuse of pain medication. What is wanted are reasons to think that my view is morally commendable and that the alternative is to be condemned. Not surprisingly, I will turn to Aristotle here.

Following Aristotle, one becomes better able to endure pain by habituation. In my case, running and martial arts built my tolerance for pain, allowing me to handle the pain ever more effectively, both mentally and physically. Because of this, when I fell from my roof and tore my quadriceps tendon, I was able to drive myself to the doctor—I had one working leg, which is all I needed. This ability to endure pain also serves me well in lesser situations, such as racing, enduring committee meetings and grading papers.

This, of course, provides a practical reason to learn to endure pain—a person is much more capable of facing problems involving pain when she is properly trained in the matter. Someone who lacks this training and ability will be at a disadvantage when facing situations involving pain and this could prove harmful or even fatal. Naturally, a person who relies on pain medication to deal with pain will not be training themselves to endure. Rather, she will be training herself to give in to pain and become dependent on medication that will become increasingly ineffective. In fact, some people end up becoming even more sensitive to pain because of their pain medication.

From a moral standpoint, a person who does not learn to endure pain properly and instead turns unnecessarily to pain medication is doing harm to himself and this can even lead to an untimely death. Naturally, as Aristotle would argue, there is also an excess when it comes to dealing with pain: a person who forces herself to endure pain beyond her limits or when doing so causes actually damage is not acting wisely or virtuously, but self-destructively. This can be used in a utilitarian argument to establish the wrongness of relying on pain medication unnecessarily as well as the wrongness of enduring pain stupidly. Obviously, it can also be used in the context of virtue theory: a person who turns to medication too quickly is defective in terms of deficiency; one who harms herself by suffering beyond the point of reason is defective in terms of excess.

Currently, Americans are, in general, suffering from a moral deficiency in regards to the matter of pain tolerance and it is killing us at an alarming rate. As might be suspected, there have been attempts to address the matter through laws and regulations regarding pain medication prescriptions. This supplies people with a will surrogate—if a person cannot get pain medication, then she will have to endure the pain. Of course, people are rather adept at getting drugs illegally and hence such laws and regulations are of limited effectiveness.

What is also needed is a change in values. As noted above, Americans are generally less willing to tolerate even minor pains and are generally willing to turn towards powerful pain medication. Since this was not always the case, it seems clear that this could be changed via proper training and values. What people need is, as discussed in an earlier essay, training of the will to endure pain that should be endured and resist the easy fix of medication.

In closing, I am obligated to add that there are cases in which the use of pain medication is legitimate. After all, the body and will are not limitless in their capacities and there are times when pain should be killed rather than endured. Obvious cases include severe injuries and illnesses. The challenge then, is sorting out what pain should be endured and what should not. Since I am a crazy runner, I tend to err on the side of enduring pain—sometimes foolishly so. As such, I would probably not be the best person to address this matter.

I wasn’t aware that the Democrats regarded fathers as unimportant. Obama seems to think that being a father is important, as does Joe Biden.

I’m not an expert on child development, but I do believe that children benefit from a good male influence. While this article is from 2009, it is still an interesting read on the subject of fathers.

While it is not uncommon to think that men and women should be the same in terms of virtues, there do seem to be differences. This is not to say that women or men lack certain virtues, just that they seem to be different in important ways. This might be cultural or biological (or both). In any case, it is an interesting and important matter with practical implications regarding child development and so on.

Good article, but it serves to highlight exactly the point Charles Murray makes in Coming Apart: that successful liberals refuse to endorse the values and behaviors responsible for their own success.

Note the following from the article you linked:

The politically correct modern notion is that as long as a child is healthy and loved, it doesn’t matter who they are raised and nurtured by. And of course if there is no father, any loving parent is integral for a child’s well being.

But the male influence in a child’s life is invaluable, irreplaceable and necessary for most of us. There, I said it.

As politically incorrect as it may sound, fathers are important, and it would do us all good to reflect on where we might be without the great male influence that our fathers have bestowed on our lives.

If Dems are so father friendly, why does she think the phrase “fathers are important” sounds politically incorrect?

I endorse the values that made me successful and consistently so. As far as it being politically incorrect, this does not entail that all or even most Democrats disagree with her. Political correctness is generally defined by a very loud minority.

I did some research on the book, Coming Apart; it looks outstanding and I think I’ll read it. One argument that Mike will make and has, is that the Left is not “against” fathers and other things we are critical of the Left for. But one book reviewer on Amazon puts it perfectly: The values of success and happiness–the very basic ones–ought not be only practiced, but preached. The Left, like Mike, practices them for themselves–they stay married mostly, they value education or at least a basic level of writing and reading skills, and they take care of their kids (when they can bear to have them) and they have strong social bonds. The Left will not preach those values, because it does not want to admit that those values are the key to its own areas of success and that those values are in fact the same values that the Puritans had. It’s “thinking outside the box” that’s important, which means we must view the Pilgrims as crazy religious zealots and modern Muslims as peace-loving and misunderstood. But these are the elite Left. They are their own class. Those not born into that class have no successful culture to teach them how to succeed. I was not born into that class. My father lived in a trailer. It took me nearly 30 years to figure out what mattered, and another six to begin to put it into practice. And I consider myself lucky to have done that well. Many others will simply end up as drug addicts, hating themselves, life, everything. This is where the Left has failed miserably. They draft laws that make it easy to be fat, dumb and very unhappy, as the lower class are. They do this under the auspices of moral relativism, which is the seed of the Left’s destruction. Many of them refuse to ardently stand against what they themselves know are unhelpful behaviors. The destruction of the black community is a prime example.

The Soviets had it right: If you want to manipulate a society and steer it in a certain direction, control that society’s elites–they determine what the society’s future is.

Reading blogs like this gives me hope…as much of a tragedy it is to read ^any stories^ which cause grief, pain, anger, and trouble to others, the one tragedy that continues to dominate our society is the same one nobody wants to address, acknowledge (I mean *really* acknowledge), or even write/talk about – prescription drug use. It’s a constant tragedy that constantly and steadily takes lives on a daily basis. This tragedy is so strong, nobody is safe. It doesn’t matter how you were raised or what class you belong to – to it, everyone is fair game…and that’s the scary part. All of a sudden, a minor injury or dental procedure that required pain medication suddenly turns to an addiction one cannot live without. Why can’t this be an open topic of conversation throughout the media and society? The more this addiction is addressed and understood, the better the odds of being able to create easier and more successful methods for people fighting this addiction to break free of it.

I do agree w/ you Michael…most, if not all, of beating this addiction comes from within – it’s the drive to succeed; the will to survive. It’s the moment when it’s determined a tiny pill will not dictate, control, or imprison ones life – not for one more second of one more day. Ever again.

Unsurprisingly, the government makes things worse writing the law such that if you mix deadly acetaminophen with the opiate it is more convenient for busy people. Acetaminophen is one of the leading causes of pain killer deaths:

The combination of acetaminophen and hydrocodone in Abbott Laboratories ABT -0.60% ’s Vicodin and its generic cousins is classified as a Schedule 3 drug under the Controlled Substances Act. That allows doctors to prescribe it by phone and write multiple refills, unlike other opioids that require a new prescription every month.

Many such combinations contain five mg of the opioid and 500 mg or 750 mg of acetaminophen. Patients who develop a tolerance to the opioid and take more and more to get relief can end up getting a big dose of acetaminophen. “We all think, gosh, it’s the narcotic that’s dangerous, but there is a separate level of concern about the acetaminophen that many doctors don’t tell their patients about,” says Sandy Kweder, the FDA’s deputy director for new drugs.